Exercising the right not to be subject to a decision based solely on automated processing, including profiling



Name / business name: (*)
Address of the center to which the right not to be subject to a decision is exercised: (*)
Zip Code: (*)
Locality: (*)
Province: (*)


Mr/Mrs.(*)
, adult,
address:
number
of
Zip Code(*)
with DNI/NIE (*),
with e-mail (*)

through this document I exercise the right not to be subject to decision based solely on automated processing, including profiling, in accordance with the provisions of articles 13 of Organic Law 3/2018, of December 5, on Protection of Personal Data and Guarantee of Rights Digital, and 15 of Regulation EU 2016/679, General Data Protection Regulation (GDPR)
In order to define the data or treatment activities I specify the following:



REQUEST not to be subject to a decision based solely on automated processing, including profiling, which produces legal effects concerning me or similarly significantly affect me, in particular in the following aspects:
- When the processing is based on the conclusion or execution of a contract, or is based on the data subject's explicit consent; I REQUEST the adoption of suitable measures to safeguard:

o My legitimate interests.

o The right to obtain human intervention.

o The right to express data subject´s point of view.

o The right to challenge the decision.

o My rights and freedoms


I request this application to be treated in the terms set out above, within one month of receiving this application.
In
,date
of
20

IMPORTANT: For the correct exercise of the right of access, a photocopy of the DNI, or NIE where applicable, of the Data Dubject must be attached to the present application, as long as it is the exercise of a right of personal ownership.

Attach file (*)


(*) Required information
NOTE: It is important that all information that is marked as required (*) is completed to allow the system to send to the form. We can not accept any form that does not have attached the file with DNI / NIE.

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